2000 Guideline: Recommendation: Combining the nicotine patch with a self-administered form of nicotine replacement therapy (either the nicotine gum or nicotine nasal spray) is more efficacious than a single form of nicotine replacement, and patients should be encouraged to use such combined treatments if they are unable to quit using a single type of first-line medication. (Strength of Evidence = B)

2008 Guideline Update: Recommendation: Certain combinations of first-line medications have been shown to be effective smoking cessation treatments. Therefore, clinicians should consider using these combinations of medications with their patients who are willing to quit. Effective combination medications are long-term (> 14 weeks) nicotine patch + other NRT (gum and spray), the nicotine patch + the nicotine inhaler and the nicotine patch + bupropion SR. (Strength of Evidence = A)